Hansard

Members will recall that on 18 December I drew their attention to a single incident in England in which it appeared that, for the first time anywhere in the world, variant CJD might have been transmitted by blood transfusion. At the time, I said that the advisory committee on the microbiological safety of blood and tissues—MSBT—had been asked to consider comprehensively whether, in the light of that incident, any further precautionary measures needed to be taken. That request was made with the proviso that such measures should not have an unmanageable adverse impact on the safety or availability of essential blood supplies. The dangers of a shortage of blood will be obvious to all, so we expected the committee's recommendation to take account of the balance of risk involved.

The committee met on 22 January and discussed a number of options for further strengthening protection of the blood supply. On the basis of the evidence available, and taking a precautionary approach, the committee has recommended that UK blood services should cease to accept blood donations from people who can confirm that they have definitely received a blood transfusion in the UK since 1 January 1980—the date after which it is believed people might first have been exposed to variant CJD via the food chain.

As I indicated on 18 December, at that time I asked the Scottish National Blood Transfusion Service to anticipate such a recommendation by preparing as a matter of urgency an implementation plan. That has been done and the plan will be put into effect on Monday 5 April—the date recommended by MSBT as being the earliest date that would allow blood services to put in hand all the necessary work.

Preparatory to implementing the plan it has been necessary to undertake a considerable amount of work to ensure its smooth and safe introduction. To reassure members that we have been addressing the issue vigorously, I will outline the most important elements of that work.

Our primary concern has been to take measures to secure the blood supply, so that operations and essential treatment are not jeopardised by the loss of blood donations from the group of donors who will no longer be able to give blood as a result of our adopting the committee's recommendation. We expect that the new policy will result in the loss of around 4 per cent of current donations, but secondary effects could increase the figure to as high as 10 per cent. To take account of the loss, the SNBTS will need a large number of extra donors to come forward over the next 12 months. There will be a doubling of its normal requirement for new donors.

The SNBTS has already stepped up its existing donor recruitment campaign. In addition, it has conducted new research into the issues that motivate people to become blood donors. Based on that research, it will launch a completely new high-profile media campaign later this year. The SNBTS will write to existing donors who are unaffected by the new policy and will ask them to make a special effort at this time, with particular emphasis on the importance of maintaining the supplies of O negative blood that are so important in emergency situations. Arrangements are in hand to introduce a screening test that will allow an estimated 2,500 donors who are currently prevented from giving blood because travel abroad to certain countries can involve a risk of contracting malaria to resume giving blood.

In addition to the essential work that I have described, it has been necessary to put in place arrangements to explain the new policy to donors and to other people who may be worried about its implications. Those include the provision of counselling where it is appropriate. The SNBTS has prepared three new information leaflets specifically for that purpose and has drafted comprehensive briefing for use in call centres where calls from donors will be handled. It has also set in motion the recruitment process for the additional nurses and donor care staff who are required. In the interim, existing staff will work additional hours to meet the need. It has been necessary to provide comprehensive training for front-line SNBTS staff in both the implementation of the policy and how to inform and support donors who have concerns arising from it.

In outlining the policy and its implications, I emphasise that we are taking this approach on the basis of scientific advice and as a precaution against an uncertain but slight risk. We believe that the risk of any individual having been infected with variant CJD as a result of blood transfusion is extremely small. Nevertheless, I realise that individuals may have concerns about how the new policy affects them and may wish to seek advice. Any patient in that situation can contact the dedicated team on the national helpline number. Any donor who is deferred under the new arrangements should speak to a SNBTS member of staff at a donor centre or session or should call the SNBTS's 24-hour donor helpline. I urge people to continue to have a blood transfusion when it is really necessary. Any slight risk associated with receiving blood must be balanced against the significant risk of not receiving that blood when it is most needed.

As I explained in January, we already have in place a range of precautionary measures to reduce the possible risk of transmitting variant CJD through blood. Since 1999, those have included the leucodepletion of blood intended for transfusion and the importation from the United States and Germany of all plasma used in the manufacture of blood products. More recently, since September 2003, all the clinical fresh frozen plasma needed for the treatment in Scotland of newborns and of children who were born after 31 December 1995—the date when exposure to BSE via the food chain ceased—has also been imported from the United States and virally inactivated. That latest measure merely augments the existing measures to provide an even greater degree of safety.

In addition, we have a responsibility to donors and patients to ensure that blood is used as effectively as possible and is used only in circumstances in which the essential benefits to the patient outweigh any adverse effects. To that end the SNBTS is collaborating with health professionals in NHS Scotland to implement the better blood transfusion programme, a key initiative endorsed by the chief medical officers of all four United Kingdom Administrations. Three key areas of transfusion practice are being reviewed: blood ordering and administration; efficient management of blood components; and, crucially, clinical effectiveness and the use of the best evidence-based practice in prescribing blood so that it is used only where there is a real need.

In April 2003, we recruited a full-time programme director to implement the programme in Scotland over the next three years. Eighteen transfusion practitioners have also been recruited from various nursing and hospital backgrounds and they are being supported by a designated senior manager in each NHS board. I believe that the programme is important and every effort will be made to ensure its success.

Obviously, we are sad to be losing some of our most loyal blood donors and I thank them for their commitment to saving lives over the years. It is essential that the potential shortfall that arises from the decision is made good and that essential blood supplies are maintained. As I have already mentioned, the Scottish National Blood Transfusion Service has embarked on a new initiative to recruit additional donors and, based on new research about potential donors, the initiative will be accelerated over the coming months. The effectiveness of the new approach will be kept under close review and, if necessary, consideration will be given to other approaches, such as enhanced blood collection arrangements, more donor sessions and the use of automated blood collection equipment that allows the equivalent of more than one donation to be taken from each patient without their being exposed to any adverse health effect.

It is important not to lose sight of the key role that blood donations play in providing essential treatment and in saving lives. The statistics are compelling. Approximately 80,000 patients in Scotland receive a blood transfusion every year. At present, less than 6 per cent of the Scottish population who could give blood do so. It has never been more important for people to come forward to donate blood regularly and I urge them to do so.